Rheumatoid arthritis diseases associated with

Berkun, Y., Levartovsky, D., Rubinow, A., et al. (2004) Methotrexate related adverse effects in patients with rheumatoid arthritis are associated with the A1298C polymorphism of the MTHFR gene. Annals of the Rheumatic Diseases. 63, 227-231. 

The disease-modifying agents used in rheumatoid arthritis are associated with a number of side effects that could influence rehabilitation. Some of these drugs, such as the gold compounds and methotrexate, may cause headache and nausea, which may be bothersome during the therapy session. Joint pain and swelling may also occur with drugs such as methotrexate and peni-... 

As was already mentioned, piroxicam also is a nonsteroidal, anti-inflammatory drug. It is used in inflammatory and degenerative diseases of the musculoskeletal system that are accompanied by painful symptoms. It is used for rheumatic heart disease, nonspecific infectious polyarthritis, gouty arthritis, rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, arthrosis, back pain, nenralgia, myalgia, and other diseases associated with inflammation. Synonyms for piroxicam are feldene, dexicam, roxenan, and others. 

Rheumatoid factors of the IgM and IgG classes have been shown to form immune complexes in serum or joint fluid either by self-association (K17, M4, M26, P13, Sll, W21) or by reaction with native IgG (C4, K17, M4, N5, Sll, W21, W22), and these appear to be the predominant immune complex material in rheumatoid arthritis (C4, Gl, K17, M4, M26, N5, Sll, W21, W22). The primary cause of rheumatoid factor production in rheumatoid arthritis is unknown. However, rheumatoid factors are known to be present in other diseases associated with chronic antigenic stimulation (C14, M14) and can be induced in vitro by stimulation with antigens, autologous aggregated IgG, anti-idiotype reagents, and polyclonal B cell activators such as lipopolysaccharide and Epstein-Barr virus (C4, Dll, F6, F7, Gil, 16, P10, S24). Rheumatoid factors, including IgG rheumatoid factors which form selfassociating intermediate-sized (11-19 S) complexes, play a major role in... 

Studies of autoantibodies in the general population allow us to determine the prevalence of specific autoantibodies among people who do not have a clinically evident autoimmune disease, whether the prevalence of autoantibodies reflects the demographic variation in disease risk and whether specific environmental exposures are related to the expression of specific autoantibodies. These studies are most feasible for the autoantibodies associated with the most common autoimmune diseases diabetes mellitus type 1, autoimmune thyroid disease, and rheumatoid arthritis. Important issues with respect to interpreting these types of studies include the type of test used and definition of a positive result. 

The influence of antioxidants (e.g. vitamin E or a-tocopherol, vitamin C or ascorbic acid, and carotenoids, including P-carotene and lycopene) on autoimmune diseases has not been extensively studied. There is some evidence that damage induced by reactive oxygen species contributes to the destruction of pancreatic beta cells, brain tissue, and joints seen in diabetes mellitus type 1, multiple sclerosis, and rheumatoid arthritis, respectively. However, there are few prospective studies of antioxidant intake and risk of autoimmune diseases. Although there is some evidence of a reduced risk of rheumatoid arthritis and lupus with higher intake or serum levels of antioxidants, there are inconsistent findings with respect to which antioxidants or foods are involved (Comstock et al., 1997 Knekt et al., 2000 Cerhan et al., 2003). Only one prospective study of antioxidants and risk of multiple sclerosis is available, and that study reported no association with intakes of vitamin C, vitamin E, or carotenoids (Zhang et al., 2001). 

Unlike rheumatoid arthritis, there is no systemic disease associated with osteoarthritis. Treatment of osteoarthritis is with NSAIDs for their analgesic and anti-inflammatory effects. Corticosteroids are not recommended and disease-modifying drugs are not effective in osteoarthritis. 

Pristane-Induced Arthritis (PIA) Model. In one strain of mice, DBA/1, injection of a mineral oil pristane (2,6,10,14-tetramethylpentadecane) into joint regions induces arthritic disease associated with a broad spectrum of autoantibody production, including rheumatoid factor, anti-collagen and antiheat shock protein antibodies, and polyclonal T cell activation (Wooley and Whalen, 1991). Later work showed the ability to modulate the disease by immunoregulatory agents, e.g., administration of IL-12 cytokine (Beech et al., 1997). However, this disease-induction model appears less frequently used, likely due to lower reproducibility between laboratories, and potential... 

Chlorpromazine was found to have no marked effect in patients with rheumatic diseases associated with pain and inflammation, but it was an effective substitute in patients who had been receiving long term corticosteroid treatment for rheumatoid arthritis and from whom the drug was being withdrawn . 

Infliximab is indicated for the treatment of rheumatoid arthritis in combination with methotrexate and for Crohn s disease. Long-term use may be associated with the development of anti-infliximab antibodies, an effect that does not appear when it is used with methotrexate. Warnings associated with the use of infliximab include risks of autoimmunity, infections, and hypersensitivity reactions. An excellent review of the properties and use of infliximab has recently appeared (84). Infliximab is more specific than etanercept, because etanercept binds to both TNFa and TNFp whereas infliximab is an antibody that binds only to TNFa. Infliximab possesses a longer half-life giving a dosing schedule of approximately every 6 to 8 weeks. 

Disease states such as uremia and arthritis are associated with immunological abnormalities. Treatment of uremic patients with pharmacologic doses of pyridoxine resulted in a significant increase in lymphocyte reactivity in mixed lymphocyte cultures. Plasma PLP was found to be 50% lower in patients with rheumatoid arthritis compared to controls matched for age, gender, race, and weight (85). All groups had similar intakes of the B vitamins. The plasma levels of PLP inversely correlated with production of tumor necrosis factor by unstimulated peripheral blood mononuclear cells. 

Michalski IP, McCombs CC, Scopelitis E, et al. Alpha 1-antitrypsin phenotypes, including M subtypes, in pulmonary disease associated with rheumatoid arthritis and systemic sclerosis. Arthritis Rheum 1986 29 586-591. 

Biederer J, Schnabel A, Muhle C, et al. Correlation between HRCT findings, pulmonary function tests and bronchoalveolar lavage cytology in interstitial lung disease associated with rheumatoid arthritis. Eur Radiol 2004 14 272-280. Camus P, Bonniaud P, Eanton A, et al. Ehug-induced and iatrogenic infiltrative lung disease. Clin Chest Med 2004 5 479 519, vi. 

Ju JH, Kitn SI, Lee JH, et al. Risk of interstitial lung disease associated with leflunomide treatment in Korean patients with rheumatoid arthritis. Arthritis Rheum 2007 56 2094 2096. 

Chemokines have been shown to be associated with a number of autoinflammatory diseases including multiple sclerosis, rheumatoid arthritis, atherosclerosis, dermatitis, and organ transplant rejection. Evidence, reviewed below, is mounting that chemokines may play a major role in the pathophysiology of these diseases and thus chemokine receptor antagonists could prove to be useful therapeutics in treating these and other proinflammatory diseases. 

In the past number of years a number of studies have shown that in a variety of diseases there is a significant oxidation of Met residues to Met(O) in specific proteins that results in a loss of biological activity. These diseases include cataracts, rheumatoid arthritis, adult respiratory distress syndrome and emphysema. The most convincing evidence that Met(O) in proteins may be involved in the etiology of a pathological condition comes from studies with a-l-PI. It is well accepted that a-l-PI is inactivated upon oxidation of its Met residues. A decreased activity of a-l-PI in lung tissue that would result in an increased elastase activity has been associated with pulmonary emphysema. In patients who have a... 

The definition of an overlap syndrome dictates that the criteria for diagnosis of both disorders (in the present context, of PM/DM and of some other connective tissue disorder), are fulfilled. It is not unexpected that those syndromes which overlap with PM/DM are also either known autoimmune conditions or ones in which an autoimmune basis is strongly suspected. The association of these disorders with PM/DM syndromes may not materially alter the basic histopathological featmes expected in PM/DM but some differences may be identifiable. The disorders most frequently associated with an overlap syndrome are rheumatoid arthritis, systemic lupus erythematosis, scleroderma, and mixed connective tissue disease. 

O Comorbidities with the greatest impact on morbidity and mortality associated with rheumatoid arthritis are (1) cardiovascular disease, (2) infections, (3) malignancy, and (4) osteoporosis. 

Besides anemia associated with cancer and CKD, anemia of chronic disease can result from inflammatory processes and occurs commonly in autoimmune disorders such as rheumatoid arthritis and systemic lupus erythematosus. In treating these types of anemia of chronic disease, the most important principle is treating the underlying disease. These patients also may have iron deficiency and should be treated in the manner already discussed. Erythropoietin therapy such as epoetin-alfa therapy at a dose of 150 units/kg three times a week also may be used in these patients. 

---